Postoperative cognitive dysfunction (POCD) is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally, studies have focused on major surgery so there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of detecting cognitive decline in elderly patients after elective inguinal herniorrhaphy procedure with general or spinal anesthesia. This observational study was conducted from June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The type of anesthesia was determined according to the anesthesiologist’s preference who is blind to the study. Patients were grouped according to anesthesia received: general or spinal anesthesia. The MMSE and MoCA were evaluated presurgery and 24 hours after the operation. The postoperative (24th hour) MMSE scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) in only the general anesthesia group (p =0.003). The postoperative (24th hour) MoCA scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were significantly lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The incidence of postoperative cognitive dysfunction was 32.9% using the MoCA and 15.2% using the MMSE (p=0,018). Early POCD is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The MoCA is an alternative tool that can be more sensitive than the MMSE to identify cognitive decline in elderly patients undergoing minor surgeries under both general and spinal anesthesia.

Background/aim: Cardiac surgery, especially in the presence of cardiopulmonary bypass (CPB), is associated with an inflammatory reaction that may promote microcirculatory alterations, in addition to the general impact on system hemodynamics. Anemia and transfusion make patients more susceptible to the deleterious effects of CPB. In this study, it was aimed to evaluate the effect of dilutional anemia, which is caused by CPB and can be treated with 1-2 units of red blood cell (RBC) transfusion, on global tissue oxygenation parameters in cardiac surgery patients. Materials and methods: This prospective observational study comprised 127 patients who had a relatively stable operation period without any major anesthetic or surgical complications (e.g., operation duration >5 h, bleeding or hemodilution requiring more than 1-2 units of RBCs, or unstable hemodynamics, requiring inotropic support of more than 5 mu g/kg/min dopamine). Patients were observationally divided into two groups: minimally transfused (Group Tr) and nontransfused (Group NTr). Global tissue oxygenation parameters were evaluated after anesthesia induction (T-1) and at the end of the operation (T-3) and compared between the groups. Results: Group Tr consisted of patients who had significantly lower preoperative hemoglobin values than Group NTr patients. The dilutional anemia of all Group Tr patients could be corrected with 1 unit of RBCs. The lactate levels at T-3, increment rates of lactate, and venoarterial carbon dioxide pressure difference (Delta pCO(2)) levels [(T-3- T-1) : T-1] in Group Tr were significantly higher than those in Group NTr. Conclusion: Dilutional anemia as a result of CPB mostly occurs in patients with borderline preoperative hemoglobin concentrations and its correction with RBC transfusion does not normalize the degree of microcirculatory and oxygenation problems, which the patients are already prone to because of the nature of CPB. Preventing dilutional anemia and transfusion, especially in patients with preoperative borderline hemoglobin levels, may therefore reduce the burden of impaired microcirculation-associated organ failure in on-pump cardiac surgery.

COVID-19,intensive care,intensive care unit,pandemic,follow-up

Background and Objectives: Although nutritional status is critical to the clinical outcomes of septic patients, studies on this topic are limited. We aim to assess the prognostic value of five nutritional screening tools (NSTs) for septic patients both at the time of admission to the intensive care unit (ICU) and five days later. Materials and Methods: This prospective observational study included adult septic patients in the ICU. Patients were divided into two groups: survivors and non-survivors. Clinical, laboratory characteristics, and NST values [The Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), Nutritional Risk Screening (NRS-2002), Geriatric Nutritional Risk Index (GNRI), and Nutrition Risk in the Critically Ill (NUTRIC)] were recorded at admission and on Day-5, and intergroup and intragroup comparisons were performed. Results: A total of 126 patients were included in this study: 97 in the survival group and 29 in the non-survival group. The non-survivors had higher CONUT and NUTRIC scores and lower PNI scores. Multivariate analysis found higher Day-5 NUTRIC scores independently associated with mortality. ROC analysis identified NUTRIC > 6 as a mortality predictor. Conclusions: Although several markers differed significantly between survivors and non-survivors, our findings show that a high Day-5 NUTRIC score was the only factor independently associated with mortality among NSTs.

Aim: We aimed to compare RT-PCR positive and RT-PCR negative patients with radiologically confirmed COVID-19 pneumonia admitted to the intensive care unit (ICU) in terms of outcome and laboratory results in the inflammation process. Material / Method: Patients who were admitted to the ICU due to respiratory failure and had typical COVID-19 pneumonia findings on thorax tomography were included in the study. Patients were grouped as RT-PCR negative and RT-PCR positive. Groups were compared for descriptive and laboratory characteristics, treatments, length of stay and outcome. Results: Lactate, D-dimer levels, and leukocyte, neutrophil counts of the RT-PCR positive group were lower than the other group (p

Background: COVID-19 is associated with high mortality in critically ill patients due to an exaggerated inflammatory response characterized by a cytokine storm. In this context, the anti-inflammatory properties of corticosteroids have emerged as a significant therapeutic option. This study retrospectively evaluated COVID-19 patients who received low-dose dexamethasone therapy in the intensive care unit, and the relationship between survival status and changes in laboratory parameters was investigated.Materials and Methods: Between June and August 2020, 80 patients with a confirmed diagnosis of COVID-19 by RT-PCR who received low-dose dexamethasone therapy (6 mg/day, up to 10 days) in the intensive care unit were analyzed. Patients were divided into two groups according to their clinical outcomes: survivors (n=41) and non-survivors (n=39). Laboratory measurements were recorded at two time points: within the first 24 hours of ICU admission (T0) and on day 5 ±2 (T1). Percentage changes were calculated.Results: The mean age of the survivor group was higher than that of the non-survivor group (77.1 vs. 62.3 years; p<0.001). At T0, WBC levels were lower in the non-survivor group (p=0.027). Regarding the change from T0 to T1 in IL-6 levels, a decrease of 76.6% was observed in the non-survivor group and 54.5% in the survivor group (p=0.045). Ferritin levels increased in the survivor group but decreased in the non-survivor group (p=0.001). D-dimer levels showed a marked increase in the survivor group, whereas a decrease was observed in the non-survivor group (p<0.001).Conclusion: The literature has strongly demonstrated that corticosteroids can improve survival in patients with severe COVID-19. The unique contribution of this study lies in revealing the changes in laboratory parameters between survival groups under dexamethasone therapy. Although the findings do not establish a direct relationship with mortality, they may serve as hypothesis-generating data that contribute to understanding the heterogeneity of clinical responses.